The Damage of Health Care Reform “By Any Means Necessary”

I have no idea whether the health care reform bill, assuming it finally gets passed in one form or another, will make things better or worse, and if you are honest about it, neither do you…and neither, I am certain, do most of the elected representatives who will have voted for it or against it (or for it and against it) by the time the dust clears. To only cite the most obvious proof, the bill’s current form was just posted yesterday, giving Congress 72 hours to read and understand over 2,000 pages of technical jargon and badly-written prose. I don’t believe I have ever read 700 pages a day for three days at any point in my life, and if I have, I know it had to be something more diverting than a health care bill.

Relying on second-hand analysis—also by individuals who haven’t read the current bill—simply puts us (and the members of Congress) at the mercy of the biases of those rendering the opinions. For example, one of my favorite commentators, Robert Samuelson, has persuasive arguments against the bill here and here, while one of my least favorite, Paul Krugman, weighs in on the bill’s virtues here and here. Now, I think Krugman has squandered his credibility by blatant untruths in the past (One howler, his infamous statement about the national health care systems of Canada and Great Britain that “We’ve all heard scare stories about how that works in practice; these stories are false” is derisively quoted almost daily by Wall Street Journal blogger James Taranto as he relays tales of national health care horrors from the London press), but the man has won a Nobel prize: maybe he’s right and Samuelson is wrong. I really don’t know.

I do know this, however: whether the bill proves to be disaster or panacea, the manner in which President Obama and the Democrats have gone about passing it has done real and lasting harm.  This is because they chose to adopt the unethical “ends justify the means” philosophy employed by radicals, terrorists and despots throughout history. This is indefensible, disgraceful, un-American and ultimately dangerous, and no health care reforms, however wonderful, can excuse it.

“By any means necessary” was coined (in French) by writer Jean Paul Sartre in his play “Dirty Hands,” while advocating the necessity of “eradicating” class divisions. It was famously quoted later by Malcolm X, whose call for racial justice “by any means necessary” was generally believed to be an endorsement of violence. The problem with such unrestrained utilitarianism, of course, is that extreme means can only be justified, if at all, when the rightness of the ends to be achieved are beyond rational disagreement, when less extreme means cannot accomplish the goal, and when basic ethical principles will not be violated to such an extent that it will warp the values of the culture. In the case of the health care legislation, none of these conditions are present. But we are seeing “by any means necessary” in action.

The use of unethical means to pass health care reform started out well within the established political culture (though well outside the new, transparent, respectful, honorable culture that candidate Obama promised to create) with false figures, deceit and exaggerations. (My personal favorite was the frequently quoted “44,000 Americans” dying from lack of health insurance, a made-up number concocted from dubious projections specifically for advocacy purposes.) Also within established norms of political dishonesty were bald assertions that health care is a “basic human right,” when this is very much open to debate: the Declaration of Independence defines our basic rights, and that isn’t one of them.

Once the bills began to emerge, though, things got worse. They were far too long and convoluted to read and understand; this was incompetent and irresponsible. None of the Senators or Representatives (or the President himself) who advocated the bills in the most emphatic terms had read them, which is a breach of diligence, and many frequently made statements in public that misstated the provisions of the bill, sometimes egregiously. Not reading a technical bill on a well-understood or narrow matter and still voting for it may be common (though, I would argue, outrageous), but doing so with a massively expensive and complex bill affecting the life of every American is irresponsible and an abuse of power. This has continued. Politicians who the public should be able to trust are still making assertions of fact that are not facts they have independently confirmed, and they are insufficiently familiar with the details to either make fair arguments or inform the public.

Here’s a revealing—and frightening— example: Jim Clyburn, the third-ranking House Democrat, was interviewed on MSNBC’s “The Daily Rundown” and asked to explain exactly how this version of health care reform is going to save the taxpayer money:

Chuck Todd: Can you explain how you get a trillion dollars in deficit reduction? I mean, the CBO didn’t make it very clear. Do you feel like you understand how it is this bill somehow reduces the deficit by a trillion dollars in those out years?

Clyburn: I think I do. What we are squeezing out of this system–remember, Medicare is a big part of this. We’re extending the life of Medicare by nine years, and if you’re taking the waste, fraud and abuse out of this, the savings that you get there will come as things grow. Savings will grow. You look at the community health centers. Savings will grow more in out years than in the first few years. So I believe–well, that’s my assessment, and that’s the way I’m explaining it to members. I hope I’m right.

Savannah Guthrie: But Congressman, you know, speaking of actually the first 10 years, I think when ordinary Americans look at this and they hear this is a bill that will cost $940 billion but will reduce the deficit $138 billion, they don’t understand how those two things go together. Can you just explain how you have to spend almost a trillion dollars to save $138 billion?

Clyburn: Well, because–sure. If you look at, as I said, the kind of savings that you build into the system, what it will save the federal government when you get people into these private insurance plans–the cost-shifting, all of that, out of the system. So if you got 32 million people coming onto insurance plans, that’s 32 million people coming out of emergency rooms; that’s 32 billion [sic] people that you don’t have to pay for in all the cost-shifting that takes place in the system. When my wife had bypass surgery, I looked on her bill. We paid $15 for one aspirin. Then that takes all of that out of the system, and that’s how you get that kind of savings, when you multiply that by the number of people that are getting primary care out of emergency rooms, you won’t be doing that. That’s the kind of stuff.

Translation: “Hummunahummuna.” Do you understand what he’s saying? Do you really think he does?

Since nobody could read the bill, this allowed the President and his allies to make general arguments that were often half-truths devised to mislead the public or avoid raising sensitive subjects. President made many “promises” about what would and would not be in the bill, knowing that they were promises he might well not be able or willing to keep. Indeed, the bill now being voted on fails to fulfill many of those pledges.  Important policy trade-offs that might erode support were not discussed, or misrepresented. For example, rather than level with the public regarding health care rationing provisions in the bills, or cost-benefit controls on treatment, advocates ridiculed Sarah Palin’s “Death Panels” warning. No, there are not literally death panels set up by the bills, but there are provisions that give caregivers incentives not to spend excessively in end-of-life situations, and that is what Palin was obviously referring to, though in excessively inflammatory language. The Democrats had an obligation of candor to the public, to have a frank and open discussion about rationing. They attacked Palin instead. It was easier than telling the public what real health care reform will, indeed must, include.

They also attacked grass-roots democracy, with Speaker Pelosi and others denigrating as “Astroturf” and “Nazis” engaged citizens who stormed Congressional town meetings to ask real questions and who often appeared to be better informed on the reform proposals than the members hosting the meetings. Some were denied opportunities to speak. As the battle shifted to the House itself, concerned citizens encountered disconnected phone lines, hang-ups and rude operators. (Here is the recent account by a constituent whose repeated attempts to get answers about the bills were reported to Capitol Hill police as “harassment.”)

Quid pro quo deals are a political staple, but Senate leadership resorted to extreme pay-offs (notably to Nebraska, Florida and Louisiana) approaching outright bribery on a scale never before seen. The President and the Democrats abandoned integrity to pass health care reform. President Obama promised transparency, but the final version of the Senate bill was crafted in secret. Time and time again, the Democrats  adopted positions they once strenuously opposed, beginning with the cynical reversal of a Massachusetts law, personally pushed by the late Sen. Ted Kennedy, that prevented the state’s Governor from appointing an interim Senator to fill a vacancy until a special election could be held. Kennedy had decisively argued that such an appointment was anti-democratic, but when the seat vacated was his own, Democrats changed the rules so an “undemocratically appointed” Senator could provide the crucial 60th vote to pass the Senate bill.

The so-called “Slaughter Rule,” the questionable parliamentary sleight of hand being used to get the Senate bill through the House, had been opposed in court by Nancy Pelosi and, among others, Rep. Slaughter herself. The White House, with the highest standard of honesty to meet, launched a website effort encouraging health reform supporters to place their names on pre-written letters to the editors of local newspapers, a clear deception and an attempt, apparently successful in many cases, to get letters published in violation of editorial standards. This really is “Astroturf.” And dishonest.

Then there are the long term costs. With the public increasingly—and justifiably—frightened about ballooning deficits, Democrats and supportive media allies have pointed to Congressional Budget Office figures that show the reform package actually reducing the deficit. The CBO, however, always bases its analysis on a bill’s own assumptions, and those in this bill, by near acclamation of every fair outside analyst, are optimistic at best and deceptive at worst. Read the review in the Opinionator column at the New York Times—hardly an Obamacare critic, and judge for yourself. Nobody really has any idea what the real costs of the bill will be….but virtually all new government programs end up costing far more than predicted. It is neither honest not responsible for the President and the Democrats to look the public in the eyes and state that this one will be the exception.

Finally, despite repeatedly saying that he sought a straight “up or down” vote in Congress, President Obama is encouraging the House to pass the bill without requiring the members to vote directly for it at all. This is a breach of accountability. It is also quite possibly unconstitutional. Even if it passes the inevitable court challenge, passing such important legislation without a clear and straightforward process is reckless and arrogant.
So let us examine how well the “Six Pillars of Character,” the building blocks of ethical conduct as delineated by the Josephson Institute, have been followed by the President and Congress:

1. TRUSTWORTHINESS:

  • Honesty in communication: The leadership has consistently sought to mislead the public. When polls complained that the party in power should be dealing with unemployment rather than health care, Speaker Pelosi began referring to the health reform bill as a “jobs bill.”
  • Candor: the public has intentionally been kept in the dark regarding what is in the bill, its true costs, its long-term consequences, and its features—and the bill’s complexity and length make it impossible for the public to uncover this information on its own.
  • Integrity: Any previously stated principle, on the part of the President or others, has been sacrificed if necessary to the advancement of the bill.
  • Loyalty: Numerous House members have reported that they have been told by the President himself that passage of the bill is essential to “save his presidency,” and that they are voting for the bill on that basis. But their first loyalty is not to the President, or the Party, but to the national interest and the public.

2. RESPECT: It is certainly within the purview of Congress to pass legislation that is not popular with the public. However, the persistent disrespect Congressional leaders have shown, not only for opponents of the bill, but the public generally, repeatedly implying that the citizens of the nation are incapable of grasping the bill’s virtues (thus relieving the bill advocates of the responsibility of explaining the bill’s provisions in clear terms) is the antithesis of the treatment American have a right to expect from their elected representatives.

3. RESPONSIBILITY:

  • Diligence: No. The supporters of the bill have not read the bill.
  • Competence: The bill is convoluted, vague, overly long and unreadable. It is incompetent legislating by definition.
  • Accountability: The Slaughter Rule is specifically designed to avoid accountability.
  • Self-restraint and Prudence: 2,000 plus pages and the addition of an expensive new entitlement program as the country faces record deficits is anything but.

4. FAIRNESS:

  • Openness: No.
  • Process: No. The process being used is unprecedented, designed to avoid rather than fulfill Constitutional requirements, and intentionally opaque
  • Impartiality: The bill is littered with special deals for unions, drug companies, and individual states.

5. CARING: At least here, President Obama and the Democrats can argue that their reform package is intended to help those who cannot afford health care. They get the benefit of the doubt on good intentions.

6. CITIZENSHIP: The means by which health care reform has been pursued could not be worse for the health of our democracy, public trust in government, the political process or national unity.

I am not going to discuss the substance of the bill. Even if it were the most transformational, effective and brilliantly crafted bill in history, it would not be worth what has been lost to pass it. The nation’s elected leaders, by adopting a “by any means necessary” strategy, have emulated  autocracies and shown a lack of faith and belief in America’s principles and institutions.  It is not just that they are ignoring the opinions of most Americans, for sometimes that is unavoidable; they are also excluding them from the political process, ruthlessly strong-arming both the public and the process when they should be respecting both.  This means they are untrustworthy, and even dangerous.

For Barack Obama to conduct the nation’s business in this manner is even worse, because he led us not only to expect better, but to expect the opposite: honesty, integrity, candor, and fairness. He has dashed the hopes of many who may not dare to hope again. His betrayal is a terrible disappointment.

The damage is done, whether the bill passes or not. For leadership, for ethics, for principle and for American ideals, only time will tell how much lasting damage been caused by these cynical and dishonest means in pursuit of uncertain ends. For now,we can only hope this sad episode is today’s aberration, and tomorrow’s cautionary tale.

5 thoughts on “The Damage of Health Care Reform “By Any Means Necessary”

  1. I’m not as hard on the health care team as you. Just three places where I have more forbearance:
    1) Savings: The CBO has vetted the bill with its customary precision and impartiality (I believe), and said it saves a bundle
    2) The 2000 pages: The Senate bill has been on the web for weeks. Obama two weeks ago released an 11-page proposal, which starts from the Senate bill and includes many of the changes the House will try to correct in reconciliation.
    3) The maneuvers: C’mon, the House is working within the rules of the House. It’s done so under both parties. The rules are open. Moreover, there will be a vote up or down on the reform: there will be no room to hide.
    4) Transparency: Yeah Obama promised it and didn’t deliver. I’ve railed against him for this. Still, his failure to produce a radical openness isn’t cause enough to damn him and the whole process.

  2. Bob: 1) Check this review of the math in the Times—hardly a conservative critic—and see if you still think the CBO scoring means anything. http://opinionator.blogs.nytimes.com/2010/03/19/checking-the-math-on-health-care/

    2) I’ve actually tried to read it. The references alone defeat you, never mind the length–there are hundreds of references back to the language of other bills and statutes. It is the ultimate “fine print.” Writing a bill like this is an intentional effort to make the process unaccessible to the public.

    3) The Rules of the two houses have never, ever, ever been combined like this to pass a bill. A series of individually legitimate rules combined in an illicit way. Even money the process is declared unconstitutional.

    4) No, transparency on anything this big, expensive and controversial is essential, not a luxury. The public has a right to it. It isn’t transparent because they know it could never get past the public and media—even a friendly media—if it was out in the open.

  3. Never trust any plan a president presents that requires 10 years to achieve “savings”. Presidents serve a maximum of 8 years, so they end up having a plan that loses money the first 8 years (or however more years they could serve) and then save all the money in years 9 and 10 through measures like “increase taxes 800%” and “take all the revenue from social security, don’t spend a dime on medicare, and put the military on E-bay”.

  4. I agree with everything you said. I thought the 3 branches were spozed to be independent. The bribery, coercion. threats used to get the votes of the democrats-with Republicans left out- we have 2 independent branches. I wish we could clean out the place and start over. Outlaw lobbying, entitlements and have a watchdog to make sure that congress behaves ethically. What I have seen this past week truly sickens me. We elected these people. /We need to clean up ourselves.

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